§Not recommended for use as an anti-neoplastic agent outside clinical trial

§Sickle cell

§No evidence that reduces severity of crisis

§Should be considered for prophylaxis

§Pregnancy and the puerperium

§Due to altered pharmacokinetics

§Twice daily dosing

§Anti-Xa activity should be measured to ensure appropriate dosing for therapeutic doses

§Monitor plt count

§If VTE early in pregnancy, can go to prophylactic dose after 6 months

§Advise not to administer further injections once labour started

§Heparin associated skin necrosis more common during pregnancy

Treatment

Venous thromboembolism

DVT / PE

§LMW heparin recommended

§DVTs can be treated at home (also possible for PE)

§IV heparin dosing

§5000units (75u/kg) bolus followed by 18u/kg/hr

§APTT 4 hours after a dose change

Cerebral venous sinus thrombosis

§Evidence is for UFH

§ICH is not a contraindication to treatment

Intraabdominal thrombosis

§Portal vein, mesenteric vein, renal vein

§Little evidence – UFH/LMW heparin followed by warfarin

Superficial vein thrombosis

§Most cases are self limiting

§Some have concurrent DVT

§Most likely with proximal involvement of long saphenous vein

§Very few studies, have concluded that prophylactic ir therapeutic doses of LMWH may reduce progression/ recurrence of superficial thrombophlebitis but not sufficient data to demonstrate a reduction in DVTs